Caring for sick, prisoners learn compassion

Once, by his own admission, Sam LeMaire was "one of the craziest individuals" at Oregon State Penitentiary. "Two words that never used to be in my life are compassion and caring," the inmate says. "I shudder to think what I used to do."

In the past 16 months, however, volunteering to care for patients in the maximum-security-prison's hospice program have made those two "c" words a daily focus.

The meaning of his work hit home shortly before his first patient - also a close friend - died. As Mr. LeMaire held his hand, Lew Miller "looked right into my eyes. It was like saying, 'Thank you for everything you did....' That's a big thing if you can help bring peace to somebody's life."

A recent development in a small number of US prisons, hospice programs are surprising many by not only easing patients' situations in their final months but also transforming the lives of inmate volunteers and affecting the milieu of prisons themselves.

"What correctional professionals are observing - and are willing to talk about - is the positive impact on their institutions," says Ira Byock, M.D., a national expert in hospice care. "Wardens and assistant wardens have told me that ... this is having a really wonderful effect."

Corrections departments began to recognize the need for hospice services in the mid-1980s, as the size of the US prison population grew, longer sentences were mandated, and the number of older inmates mushroomed. Tougher attitudes toward crime meant parole boards were less likely to give "compassionate releases" to sick inmates. More began dying inside the walls (2,500 in 1998).

The first prison hospice programs opened in 1987. Now there are about 20, with at least a dozen more being planned. Oregon State Penitentiary trained its first inmate volunteers in 1999, using the same 36-hour course community hospice workers get.

"It's amazing to watch men caring for other men," says Chaplain Judith Steele, who is on two interdisciplinary teams running the hospice. "In community hospices, most volunteers are women.... In here, men with tattoos, used to being macho and not showing emotion ... you watch them tenderly shave their friends, or feed or bathe them.

"This program gives permission to an inmate to have empathy and demonstrate it. Nowhere else is that permission given - prison rules prevent you doing favors for other inmates."

Kyle Gray, who has a 30-year sentence for robbery says, "Before I started volunteering, I was a very selfish person. I didn't care about anybody else or who I walked over to get what I wanted. It's ironic, ... by coming out of myself, I get a lot in return." He says he has learned patience, for example, something in short supply his whole life.

Similarly, LeMaire, serving a life sentence for murder, is almost in awe at how he has learned to care and to build trust. He says he brings those values into his work as a clerk in the prison's legal library. He volunteers in the hospice four hours a day, five days a week, after his full-time job.

Dr. Byock, director of Promoting Excellence in End-of-Life Care (a program of the Robert Wood Johnson Foundation), recently visited the penitentiary.

"I've lost count of how many hospice programs I've visited over the years," he says, "but rarely have I been as excited as by what I saw happening at Oregon State Penitentiary. These guys ... are living out a commitment to this project and one another that inspires my deep respect."

Byock spoke at an informal meeting attended by some 40 inmates from the prison population. "Many expressed appreciation for what their fellows were doing and said they'd like to become volunteers at some point," he says. "I felt like I was looking into the creation of community at its most rudimentary form - it was a very vibrant energy."

The Oregon program is one of four demonstration sites in a project funded by a foundation grant to the Volunteers of America. Its GRACE project involves national groups from corrections associations to health agencies to prisoner advocacy groups, and is developing standards for hospice care in prisons. The other sites are in New York, North Carolina, and the federal women's center in Fort Worth, Texas.

When the idea arose for prison hospice programs with inmate volunteers, "some correctional practitioners worried there might be problems, such as inmates trying to deal in contraband or soliciting from the families of terminally ill patients," says Madeline Ortiz, a corrections specialist at the US Justice Department's National Institute of Corrections.

That concern was dispelled quickly, she says, "as it became clear that it was a positive development - both for the patient and the inmate caring for him."

The volunteers are usually looking to give something back. "Out of our first group of 18 volunteers, 15 were lifers," Chaplain Steele says. "[As murderers], they took something they know they can never give back, so they are trying to make amends to the extent they can."

Hospice patients, of course, are the first concern. Efforts are made to help them deal with physical, emotional, and spiritual needs, with fears and regrets.

"The patients have issues of forgiveness that become very big," Steele says. "Forgiving someone for abusing them in childhood, or seeking forgiveness for their crimes or the way they have treated others."

Often problems relate to family ties. Many inmates have lost contact with family or been abandoned by them. If family members do live nearby, they are allowed more access to a relative in hospice - and so are members of the patient's prison "family."

"This gives inmates the sense the administration is trying to think compassionately about the situation," Steele says. "And there is a ripple effect in the prison."